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        <p>氧化锆被唾液污染的处理<br>使用碱性制剂（义获嘉）<br>第一步：试戴后无油空气干燥<br>第二步：涂布Ivoclean反应20s<br>第三步：彻底冲洗干净，干燥<br>第四步：涂氧化锆处理剂。<br>8.氧化锆界面处理总结<br>试戴前喷砂-氧化锆处理剂涂布-试戴-如果被污染，酒精/超声-如果试戴前未用处理机，用喷砂/Ivoclean处理，再涂处理剂-粘冠。<br>建议试戴前涂处理剂。<br>第三节 水门汀的分类与选择<br>1.水门汀的概述<br>设计用于修复体、桩核等在口腔环境内形成稳定持久的固位。<br>要求<br>1）粘接水门汀需有足够的抗溶解性<br>2）粘接水门汀通过机械嵌合和化学粘接获得足够的粘接力<br>3）在拉应力下有高强度、良好的操作特性<br>4）与被粘接组织有良好的生物相容性<br>2.水门汀的分类与属性特点<br>A.非树脂基水门汀<br>A1.磷酸水门汀<br>1)临床常用，但有很大缺陷：硬度低、有溶解性、缺少粘接力、不适合粘接全瓷冠<br>A2.玻璃离子水门汀<br>特点：1）无树脂成分。2）低膨胀系数。3）释放氟属于碳酸类。4）与牙体有一定的化学粘接力。<br>缺点：1）机械强度低。2）无法用于高应力区。3）适合固位好内冠增强型修复体。4）因为是磷酸类无磷酸根与氧化锆无粘接力。<br>树脂改良玻璃离子水门汀<br>有树脂成分，属于碳酸类，与氧化锆粘接力低。<br>B.树脂基水门汀<br>B1.传统树脂水门汀<br>有树脂成分无粘接成分（碳酸或磷酸）<br>依赖于涂底剂（偶联剂）/粘接剂的粘接<br>B2.自粘接树脂水门汀<br>含有树脂、磷酸。<br>3.水门汀的选择<br>经典的树脂水门汀<br>对于厚度大于1.5mm的亮色调氧化锆颜色和小于0.5mm暗色调氧化锆推荐使用双固化材料。<br>第四节 预备体界面处理<br>1.不同预备体界面的分类及处理<br>1)氧化锌-丁香酚(未做IDS)<br>会影响树脂聚合<br>喷砂强度-2.8bar<br>喷砂角度-60度（扫）<br>喷砂距离-1-2cm<br>喷砂时间-2.5s</p>
<p>35%磷酸酸蚀釉质边缘15-30s<br>强吸吸掉磷酸水雾冲洗15s<br>强吸吸去牙本质表面多余水分保持微湿<br>釉质边缘可涂95%乙醇。<br>涂布SBU10-15s<br>重复一次<br>轻吹10s至表面发亮无材料流动（轴壁与肩台之间不能有材料淤积）<br>固化10s<br>2)IDS表面<br>喷砂强度-2.8bar<br>喷砂角度-60度（扫）<br>喷砂距离-1-2cm<br>喷砂时间-10s<br>砂粒直径&lt;50微米<br>35%磷酸酸蚀釉质边缘15-30s<br>强吸吸掉磷酸水雾冲洗15s<br>干燥IDS及釉质表面<br>涂布SBU10-15s<br>重复一次<br>轻吹10s至表面发亮无材料流动（轴壁与肩台之间不能有材料淤积）<br>固化10s<br>3)漂白后<br>漂白4周后牙体操作流程<br>35%磷酸酸蚀釉质边缘15-30s<br>强吸吸掉磷酸水雾冲洗15s<br>强吸吸去牙本质表面多余水分保持微湿<br>釉质边缘可涂95%乙醇。<br>涂布All-Bond3 10-15s<br>重复一次<br>轻吹10s至表面发亮无材料流动<br>固化10s<br>2.标准粘接流程<br>喷砂后涂布氧化锆处理剂<br>全酸或自酸粘接处理并固化<br>双固化树脂水门汀粘固<br>第三章 玻璃基陶瓷<br>第一节 玻璃基陶瓷<br>最常用的为铸瓷。<br>贴面、嵌体<br>第二节 玻璃基陶瓷的粘接模式及粘结套装<br>a.粘接模式<br>1）HF酸蚀的机械粘接模式<br>产生微孔，与粘接树脂形成树脂突。<br>2）硅烷化的化学粘接模式<br>硅烷与修复体和粘结剂之间形成化学连接。<br>b.玻璃基陶瓷粘接的必要条件<br>粘接的最高境界就是用什么都能粘。<br>HF，处理修复体组织面。<br>磷酸，处理基牙。<br>硅烷偶联剂<br>瓷粘接剂（非必要）<br>树脂粘接剂（成膜厚度薄）<br>树脂水门汀（双固化-嵌体+光固化-贴面）<br>第三节 粘接系统<br>a.物理粘接模式<br>1）研磨-砂纸（不建议）<br>2）喷砂-氧化铝粉（不建议）<br>3）金刚砂打磨-车针（不建议）<br>4）酸蚀-HF酸处理<br>b.铸瓷与HF的作用原理<br>①<br>4HF（aq）+ SiO2(s) -&gt; SiF4(g) + 2H2O(I)<br>四氟化硅是气体，同时暴露的硅醇基。<br>②<br>4SiF4(g) + 3H2O(I) + 2HF(aq) -&gt; 3H2SiF6(aq) + H2SiO3(aq)<br>H2SiF6(aq) + MO(金属氧化物） -&gt; M2SiF6(aq) + H2SiO3(aq)<br>生成六氟硅酸盐，白色。<br>③<br>处理后界面的清理。<br>残留酸：<br>影响：持续的酸蚀作用、界面酸性环境影响树脂水门汀的聚合<br>处理：中和粉。<br>（现在使用HF凝胶，已经不用了。很容易冲洗干净）<br>沉淀物<br>水冲洗：无效。<br>高压水枪1min：有效，但没设备。<br>超声荡洗2min：有效。<br>37%磷酸搅动清洗1min：有效。</p>
<p>个人总结：氧化锆修复体粘接的流程：试戴前喷砂-氧化锆处理剂涂布-试戴-如果被污染，酒精/超声-如果试戴前未用处理机，用喷砂/Ivoclean处理，再涂处理剂-粘冠。水门汀常用的有玻璃离子和树脂水门汀，对于厚的氧化锆修复体，建议用双固化的树脂水门汀。预备体界面分为氧化锌丁香酚界面、IDS界面、漂白充填治疗后界面，分别有不同的处理方法，然后按流程粘接修复体。玻璃基陶瓷的粘接，主要原理是HF处理形成机械粘接，硅烷处理形成化学粘接。HF处理的原理是溶解修复体的氧化硅，形成空穴。另外HF处理会形成六氟硅酸盐粉末，用37%磷酸处理1分钟。HF处理还会暴露硅醇基，利于硅烷处理。</p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的CSDN博客地址：<a target="_blank" rel="noopener" href="https://blog.csdn.net/zwdnet">https://blog.csdn.net/zwdnet</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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